title: Alcohol outlet availability and excessive alcohol consumption in breast cancer survivors.
abstract: BACKGROUND
  Breast cancer survivors who consume alcohol excessively are at increased risk of recurrence and have worse prognosis. Because the environments in which people live shape many health behaviors, there has been increased attention to how neighborhood environments (eg, alcohol outlet availability) may influence alcohol consumption. The authors hypothesized that proximity to alcohol outlets increases the likelihood of excessive consumption (ie, more than 1 drink/day) among breast cancer survivors independent of their personal or neighborhood characteristics.
  
  
  METHODS
  With the Missouri Cancer Registry, the authors conducted a cross-sectional study of 1047 female breast cancer survivors (aged 27-96 years) 1 year after diagnosis. Using telephone interviews, the authors obtained data regarding survivors' alcohol consumption during the past 30 days and several covariates of alcohol use. They also obtained street addresses of all licensed alcohol outlets in Missouri and calculated the road network distance between a participant's address of residence and the nearest alcohol outlet, using a geographic information system. Logistic regression was used to determine if distance was independently associated with excessive alcohol consumption.
  
  
  RESULTS
  Eighteen percent of participants reported consuming more than 1 drink on average per day. Women who lived within 3 miles of the nearest outlet were more likely to report excessive alcohol consumption (odds ratio: 2.09; 95% confidence interval: 1.08, 4.05) than women who lived at least 3 miles from the nearest outlet in adjusted analysis.
  
  
  CONCLUSIONS
  Opportunities exist to reduce excessive alcohol use among breast cancer survivors through policy (eg, restricting number of alcohol outlets) and behavioral (eg, counseling) interventions.
authors.affiliation: Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, Saint Louis, MO 63108, USA. mschootm@dom.wustl.edu
authors.forename: Mario
authors.initials: M
authors.lastname: Schootman
authors.forename: Anjali D
authors.initials: AD
authors.lastname: Deshpande
authors.forename: Michael T
authors.initials: MT
authors.lastname: Lynskey
authors.forename: Sandi L
authors.initials: SL
authors.lastname: Pruitt
authors.forename: Min
authors.initials: M
authors.lastname: Lian
authors.forename: Donna B
authors.initials: DB
authors.lastname: Jeffe
mesh_terms: D000368:Aged; D000428:Alcohol Drinking; D001943:Breast Neoplasms / Q000150:complications; D003132:Commerce; D003430:Cross-Sectional Studies; D004777:Environment; D000431:Ethanol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D040362:Geographic Information Systems; D015438:Health Behavior; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008875:Middle Aged; D008923:Missouri; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000517:prevention & control*; D016017:Odds Ratio; D012111:Residence Characteristics; D012309:Risk-Taking; D012959:Socioeconomic Factors; D017741:Survivors
chemical_list: D000431:Ethanol
keywords: community health; hazardous drinking; lifestyle change; neighborhood; primary care